I will admit that I was a bit overwhelmed with all that transpired recently on this blog.

My original goal to discuss the potential gender discrimination existing regarding the recommended ages for gamete donation was usurped into a rather emotional discussion on merits and evils of gamete donation itself. Some of the posts were so inflammatory that I have been advised by others to wipe out all the comments so as to do no harm to others that may eventually read them. For at least now, they will remain.

So many very complex issues were discussed simultaneously; some that were reasonable while others quite unreasonable and I was not even sure where to begin. To carefully start, I believe there are three perspectives that need to be better understood involving the gamete donor, the gamete recipient and the donor-conceived offspring.

The gamete donor’s perspective

Donors may donate for a host of reasons that may include monetary reimbursement, but nearly all will donate, at some level, so that individuals who might not otherwise raise a child can do so. Many donors will already have children or may have somehow been touched by infertility though a family member, friend, loved one, or even through media stories.

Some donate blood and/or their time and others donate their money. The difference with egg and sperm donation is that they involve individuals clearly giving a part of themselves. Do donors all understand the long-term effects of the donation? Perhaps some do, but not all. Do they wonder about the children their DNA helped to create? Perhaps, yes for some. Do they regret the donation? A vocal group will say “yes” but the many gamete donors who are content, at peace and even proud of their decision are silent in the wings, not feeling the need to make their past decision to donate known. Does that mean they are embarrassed by their past decision? Perhaps a few but I suspect most will simply state it was a private decision and not for others to judge or be involved in.

Was it wrong for them to have donated eggs or sperm as some might lead us to believe? I would emphatically answer “no.”

The gamete recipient’s perspective

Most patients who accept donated eggs and sperm do so reluctantly. Single women and same-sex couples may not have many options available to them and may enter the process more willingly. For the majority using donor gametes though, they are doing so because they or their partner are unable to use their own gametes to create and raise a child. Reluctance is the common denominator in their decision.

To simply state patients seeking donor eggs and/or sperm should adopt is naive. Many patients can’t adopt for a host of reasons including age, social situations, overall costs or personal medical history. Still, adoption is a viable option for some and infertile patients go through adoption all the time.

Others patients still want to experience pregnancy and birth. Is it selfish that they want this? I do not believe it is inherently selfish to want to experience something so basic in life as reproduction. It is a drive that goes to the core of all species. The reproductive process brings them and their partner (when they exist) closer in ways that are difficult to otherwise replicate. If one condemns reproduction using donated gametes as selfish, I suppose one should condemn all reproduction as basically selfish, especially when there are existing children who could be adopted. Many patients feel that reproduction comes close to an inalienable right that is not to be interrupted or disturbed by those who disagree.

Patients that reproduce using donated gametes are not “social parents,” as some would like us to believe while trying to diminish the importance of these parents. They are parents in every sense of the word. As I have written before, being a parent has to do with being there emotionally, physically and financially for future decades to come. Being a genetic parent may only take a few quick minutes of sexual activity. I will state the genetic contribution is important, but in the scheme of things, only a very small part of the creation of a child and a family.

DNA does not a family make – it is only part of the equation.

The donor-conceived offspring’s perspective

This is where the issues of gamete donation become so complex. As I have written before, I feel that my field has not paid enough attention to the perspectives of these individuals because they were never our patients. In fact, their very existence would not be was it not for our work bringing donors and recipients together. As a result, we have an inherent responsibility to donor-conceived offspring, having assisted in their creation.

Is it better that they never should have been conceived and born, eventually experiencing all that the world has to offer? I don’t see how that could ever be thought of as true. Inherent good is created when these special individuals grace our world.

Do they have a right to know their genetic background? Perhaps they do have a moralright to know, but this frequently comes into conflict with the right of privacy of the gamete donors and recipients. Would I want to know? I think the answer is “yes.” If I were a recipient of a donated gamete, be it eggs, sperm or both, would I want to be able to make the decision about telling my donor-conceived child? I also think the answer is “yes.” So, how can we possibly reconcile these potentially conflicting rights?

We need compassion, understanding and respect.

Compassion

We need to be better aware of how donor-conceived offspring feel. They will be curious about the donors. They will be interested in connecting with half-siblings, especially when they have no other siblings in the family in which they were raised. We need to consider how the donor-conceived offspring will tell their future or current partners about their genetic family. We need to understand that they will want to tell their own children about their ancestry.

Understanding

We need to better understand how disclosure will affect all parties involved. There is a great deal of angst and fear regarding disclosure with the recipients fearing most that their donor-conceived child or children will not love them anymore after they find out they were a product of gamete donation or after they connect with the gamete donor. We need to help move society and religion forward so donors and recipients will not be at risk for condemnation by friends, family or retaliation from their own religion. This will take a great deal of time and patience.

We need follow-up and well-designed research examining the effects of disclosure on all parties. Only by gathering information can we can share with donors, recipients and donor-conceived offspring the likely outcomes of disclosure and open-identity. We need to move from uncertainty to knowledge and from fear to hope.

Respect

There is a great deal of disrespect abounding on the topic of gamete donation and passions are running very high as was evident in the recent comments on my blog. The perspectives have almost become religious in character with extraordinarily narrow and unbending belief systems incapable of contemplating another viewpoint. Zealots want to indoctrinate all, bringing everyone to their own perspective, which they view as the only right one. We all need to take a step back and breathe. If we all realize that we are in this together, trying to do what is best dealing with all three perspectives, then we will work through our differences and come up with alternatives that will work best for the greatest number of people. We will never please the zealots but we can try to care for the greatest number possible.

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Possible solutions

I don’t pretend to have all the answers here and I’m not even sure I have asked the right questions yet. Having worked in this field for almost 23 years though, perhaps I have a perspective that could have some value.

Registry

A central registry, where information about donors, recipients and donor-conceived offspring could be stored, is an alluring concept but important practical issues abound. Who will pay for it, what information will be stored, who will have access to the data and will the information be truly secure are all questions that need to be answered before we undertake such a venture and before we put patients and families at risk. Understanding that we have already succeeded in collecting and reporting ART data though the CDC/SART, I do feel that we might be able to successfully build a data collection system for egg, sperm and embryo donation procedures. A multi-disciplinary discussion guided by the ASRM or a yet-to-be-formed special interest group is probably the best place to start working closely with our peers in other countries who have already initiated this process. I am concerned if we do not do this voluntarily, politicians who may have a meager understanding of the true issues will force it upon us.

Open identity

Creating gamete donation procedures with expanded open identity options would seem potentially to be the best of all worlds. It doesn’t mean that all donations must be open identity (i.e., it shouldn’t be mandated or legislated) for if we force this option on all, we take choice out of the hands of those involved and risk depletion of the gamete pools that are needed for so many.

I do not necessarily agree that open identity will be the answer for all of the problems but it could, most of all, benefit the donor-conceived offspring. Additional work must be done to also decide how and when the identity of the donor should be presented to the donor-conceived offspring. If we are creating an open gamete donation option for the children’s good, it is hard to argue that this information must not be released until they reach age 18 or 21. For the good of the child, having some sort of connection to the donor might indeed be best if initiated in the truly formative years and, certainly, before age 10.

Summary comments

Egg, sperm and embryo donation procedures are not inherently evil. They build families where they would otherwise not exist, an inherent good. We all need to better understand the three perspectives of donors, recipients and the donor-conceived offspring and, through compassion, knowledge and respect, work better together for the betterment of all the parties involved. This issue is a moving target and I beseech all those that feel so strongly on this topic to honor and listen to the opinions of others, understanding there is no right answer for everyone any more than there a single correct religion. I ask all to try to reign in all the emotion and focus this valuable energy towards discussion rather argument, compassion rather than condemnation, education rather than persuasion and respect rather than intolerance.

We have a long way to go but I feel we can get there together by understanding that each of us has much to learn from each other.

P.S. For those that would like to review a somewhat scholarly summary on disclosure in embryo donation from the perspective of the embryo donor, embryo recipient and the donor-conceived offspring, I encourage you to read one of my somewhat long, but comprehensive reviews on the topic by visiting my embryo donation blog by clicking here.

I recently had the opportunity to be on Theresa Erickson's Internet radio show, Voice America. Known as the Surrogacy Lawyer, Theresa is renowned for her work on behalf of many patients faced with infertility looking for third party options. During my interview, we discussed the option of embryo donation from the physician, recipient and donor perspectives.

One of our donors, Tori, discussed her infertility experience as well as her and her husband's decision to donate their remaining embryos following a successful IVF procedure culminating in the delivery of her twins. You can see a picture of her twins and information regarding her amazing embryos by visiting our website.

Tori's Twins!

Tori and her husband decided that they wanted to “pay it forward” to other infertile couples. Here is a combination of her own words during the interview and some other comments she told me separately:

“Donating the embryos brought on a wide range of emotions; some expected such as the happiness to help another infertile couple, peace in setting the embryos ‘free’ by finally making a decision on their fate and others were a bit of a surprise such as a brief feeling of sheer panic that I ‘forgot’ something after leaving the clinic. The donation experience to me is like paying it forward to other infertile couples. I did not see any reason to leave the embryos suspended in time, did not want to see them destroyed and there was no reason to donate them to stem cell research when there are so many infertile couples in the world going through the same anguish I went through.

That feeling of anguish kept coming back, that longing and yearning for something that was so easy for others to have, yet so very difficult for me to obtain. I wanted to help someone relieve that awful feeling and by donating my embryos, I had a very good chance of doing just that.”

Tolisten to the show, please visit our Audio Gallery and click the play button to the right.

I am so thankful for people like Tori and other donors who consider giving their frozen embryos life while helping other people building their families at the same time. If you'd like more information on the process, please visit our embryo donation page on our Website, contact us at (239) 275-8118 or e-mail us at Fertility@DreamABaby.com.

Please stay tuned for the launching of our expanded embryo donation program called Embryo Donation International! I hope that many couples will consider to “pay it forward” just as Tori and her husband did.

Your thoughts and comments are always welcome.

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Embryos are created through the Assisted Reproductive Technologies (ART). In order to minimize multiple pregnancies, excess embryos are cryopreserved in liquid nitrogen for future use. Eventually, a caring and compassionate couple, the donating parents, decide to donate these frozen embryos. Rather than destroy the embryos or donate them to science, the donating parents believe their cryopreserved embryos deserve a chance at life and a needy individual or couple deserve a chance at parenthood. It is a wonderful and amazing gift. To learn more, visit http://www.dreamababy.com/embryo-donation.htm.

Recent Comments

I was in a meeting starting Friday night, all day Saturday and then went to yet another one on Saturday evening, so I was a bit delayed on my post regarding the 4th episode of The Fertility Chase (TFC). I hope you will find that it was worth the wait.

A Woman’s Reproductive Age:
Maria Bustillo, Kimberly Thompson and Juergen Eisermann were the Reproductive Endocrinologists from the South Florida Institute of Reproductive Medicine in the first segment. I know all of these physicians and they do a very good job.

Angelique was the infertility patient. She went through six intra-uterine inseminations (IUI’s). I couldn’t tell if oral or injectable medications were used. Laparoscopy was the next step wherein “unexpected” problems were discovered. In vitro fertilization (IVF) was used next and she conceived and delivered her son, a “mini-me” of her husband. Really, the likeness was quite striking.

The theme was the influence of a women’s age in their quest for parenthood, a topic that has resounded through nearly all the episodes of TFC. It is the single most difficult issue for us to deal with as we cannot make ovaries younger or increase the production of healthy eggs when few exist.

Angelique did highlight a couple of interesting points. All of us have been caught by doing IUI procedures followed by a laparoscopy (out-patient belly button surgery) only to discover that the IUI procedures were unlikely to work because of problems found at the time of surgery. My feeling is that if surgery is to be contemplated, that one not perform too many IUI procedures before doing it. Understand, however, that laparoscopies do not always significantly improve the natural pregnancy rates, it is a “catch-22”. Even so, laparoscopies do often give us a diagnosis and provide us with enough information and confidence to continue the IUI’s procedures or to quickly move to other alternatives. As they say, hindsight is “20/20”, and it is always easier to look back and think of treatments that we would have modified and a bit tougher to do it from the get go.

My last comment has to do with fact that Angelique had infertility insurance coverage. I have seen numerous cases where the treatment plan was different compared to someone without coverage. For example, where a non-covered patient may only try 3-4 IUI procedures, a covered patient may try 6. While not a tremendous difference, each failed month takes it toll on the patients and it so easy to let the insurance coverage influence the treatment plan. I call this the “insurance trap”.

Polycystic Ovarian Syndrome (PCOS):
Edward J. Ramirez, M.D., from The Fertility and Gynecology Center, Monerey Bay IVF, was the Reproductive Endocrinologist in the second segment. Brandi and Monique were the patients featured.

For the readers, the diagnosis of Polycystic Ovarian Syndrome (PCOS) requires that at least two out of three of the following are true:

The woman doesn’t release her eggs on a regular basis.

Male hormone levels are increased in the blood or there is an excess of facial or body hair in such locations as the chin, neck, back, abdomen and chest. Acne can sometimes also present.

That each of the ovaries have more than 12 small cystic structures, which we call antral follicles.

PCOS is the most common endocrine disease in reproductive age women affecting about 6% of the population. It is a very common cause of infertility.

Dr. Ramirez stated that 80% of the patients didn’t ovulate (release their eggs) on either clomiphene citrate (Clomid) or letrazole (Femara). I believe that number is a bit high. In fact, there is ample evidence that it is more likely that 80% will ovulate on the medications, although not all of these will conceive. Nevertheless, these oral medications are a good starting point in addition to treating the other issues that are commonly present including pre-diabetes and even diabetes itself. Problems with weight are also found in about 80% of the PCOS patients so diet and exercise are an essential, although difficult, component of the treatment plan.

I was struck by the words and phrases these young women used to describe their diagnosis of PCOS and infertility including “alone”, “not female”, “jealousy”, “shame” and “depression”. I was very concerned about Monique’s comment that she didn’t have “the will to live”. This level of depression must be treated seriously and be carefully followed by the clinician. Fortunately, Monique conceived and delivered. I hope Brandi soon does the same. Perhaps TFC can follow up on Brandi in the near future.

Male Factor Infertility, Spinal Cord Injuries:
Dr. Randall B. Beacham from the University of Colorado School of Medicine was in the next segment discussing spinal cord injuries inmen. Jasmin was the injured male patient who apparently was unable to ejaculate naturally. Dr. Beacham is well respected and well published.

This couple told a story of being seen by four doctors being told different things before finding Dr. Beacham. Male factor infertility really requires the assistance of a highly trained Reproductive Endocrinologist who also sees male patients and/or a Urologic Infertility Specialist such as Dr. Beacham. Both of these types of physicians are a bit rare so infertility patients have to seek them out.

Jasmin entered an experimental study where clomiphene citrate (Clomid), a medication usually reserved for women, was given to him in the hope of stimulating sperm production. This medication has been studied in the past and was not shown to be useful in the vast majority of men suffering from male factor infertility. I had to laugh when Jasmin said he bought six pairs of shoes and had an urge to shop while on the medication. In reality, Clomid hopefully increases the male hormone in men and the female hormone minimally, if at all. I think he just wanted an excuse to go out shopping.

It appeared that Dr. Beacham was able to stimulate ejaculation through a technique called “electro-ejaculation” wherein a probe is placed into the rectum and electrical current is released resulting in a type of spasm that produces an ejaculate. His wife underwent hormone stimulation of her ovaries to increase the number of targets for the limited quality and quantity of sperm. Presumably, she had an IUI procedure and conceived a little girl. The macho Jasmin clearly wanted a boy but I’m sure he will treat his little girl as a princess.

My only concern in this piece was that it needed to be emphasized that Clomid has not been found to be useful in the previous randomized and controlled studies and had fallen out of favor. I did a search to see if there were any prospective studies published on the subject over the past 10 years and found none. Dr. Beacham made it quite clear that there were no magic medications for male infertility but he apparently feels that this medication may be of some use in this particular kind of patient. If it is to be used, I urge that it be done in a study setting, as it was with Dr. Beacham, so as to not give false hope, waste time or result in unrealistic expectations.

Re-cap:
The last segment was a collection of past segments, including ours from last week about embryo donation. The show ended with the comments that infertility patients were misinformed, misled, suffered in silence and felt powerless. Clearly, TFC is trying to change that and more power to them. I’ll certainly support their effort.

As always, if you agree to disagree with whatever I write, please do not be shy and leave a comment or two. Questions will also be answered when possible. Until then, go forth and try to multiply.

This Saturday “The Fertility Chase” will recap our segment on embryo donation and the story of Amy and Walter Costello. The show will air at 8:30 a.m. on WEtv, the Women’s Entertainment cable television network. For more information, visit www.dreamababy.com or call 239-275-8118.

Pre-Implantation Genetic Diagnosis:
Edward L. Marut, M.D., from the The Fertility Centers of Illinois was featured in the first segment. The infertility couple, Kelly and Tom, was unable to conceive over a three years. Basic treatments were performed without success wherein they underwent In Vitro Fertilization (IVF) twice and failed. The final and successful outcome occurred when they did a third IVF procedure combining it with Pre-implantation Genetic Diagnosis (PGD). In PGD, a single cell from each of the embryos is screened for chromosomal defects such as Down’s syndrome. Nine out of the possible 24 chromosomes were examined. PGD is commonly done for genetic disease, gender selection, to transfer a single embryo, recurrent miscarriage and when there is a history of failed implantation such as this couple. Apparently only two out of twelve sampled embryos were probed as normal. A male child was eventually delivered.

As women age, the quality and quantity of their eggs decrease. In this case, quality seemed to be the issue. While not every one agrees, it is thought that PGD may decrease miscarriage rates and decrease the delivery rates of genetically abnormal offspring such as Down’s syndrome. I too have used PGD to decipherer the reason why embryos have failed to implant and will frequently find that nearly all of the embryos are indeed genetically abnormal. PGD has its strengths and weaknesses, however, in this particular instance, it may truly have saved some time and heartbreak. I thought the piece was well done.

Embryo Donation:
OK, this is going to be hard to review as this was my own segment In the making for over a year, I thought Exodus Productions did a wonderful job with it. To view, please visit: http://www.vimeo.com/11762266.

Kerry (commissioning parent) and Christiana (surrogate) did an amazing job opening up their lives to the media to tell this important story.

Christiana (below) is the surrogate carrying Kerry's donated embryo.

Walt and Amy’s side of the story was that they would much rather donate their embryos than other alternatives should they never use them themselves. Amy is set to deliver very soon and I hope they use their own beautiful embryos for themselves but, in case their first child is a little hellion and they decide not to have any more (which I doubt), I would be more than happy to find a wonderful home for them.

Walter and Amy with baby in between.

None of this entire story would have been possible without the generosity of the couple that donated the embryos to Kerry. In addition, they did not stipulate that we couldn’t give their embryos to a single woman. This was an amazing gift from undoubtedly an amazing couple. Since these embryos came from a distant facility and not our own, I will probably never have the privilege of thanking them directly.

We will be covering the topic of embryo donation in great detail in the months to come. Right now, we have over 140 abandoned embryos and we are trying to get these designated to either personal use or embryo donation. I feel we are both patient and embryo advocates.

All kidding aside, I surely hope you enjoyed the segment as much as I did.

Egg Donation:
The third segment had many players from Long Island IVF, one of the busiest IVF facilities in the country. Reproductive Endocrinologists Dr. Daniel Kenigsbert and Steven Brenner and Embryologist Glenn Moodie, Ph.D. were the experts. Carolyn and Nicholas were a infertility couple and Donna was also a patient who sought treatment. The theme had to do with egg donation. As stated a few paragraphs above, as a woman ages, the quality and quantity of eggs decreased. At times, we also see young women who surprise us in that they seem to be very close or have actually entered menopause. When there aren’t enough healthy eggs around, an excellent option is egg donation.

I was struck by Donna’s story of four IVF cycles with one physician and another four with a different one. New York is a mandated state, which means that a certain amount of infertility has to be covered by insurance companies. I have unfortunately found that insurance coverage often leads to poor decisions. I had one patient recently that was told she was had to undergo six intra-uterine insemination procedures before doing IVF. The problem was that her Fallopian tubes were very damaged and severe pelvic adhesions were present. I recommended moving forward with adoption or IVF but IUI procedures were not on my radar screen. Doing IUI procedures was a very foolish and expensive (i.e., wasteful) step before IVF in this instance. Getting back to The Fertility Chase, Donna probably needed to move to egg or embryo donation long before the eighth IVF procedure. If none of them had been covered, she surely would have made the decision sooner and with less heartbreak.

Lastly, the egg donor stated it took weeks for her to complete the pages of needed information. Our patients have told us that it took less than 30 minutes to do it on our website (http://www.dreamababy.com/eggdonation.htm) . These are young patients and their medical histories should be pretty simple. Perhaps the donor was just being overly cautious but the TFC viewers or my readers should know that it isn’t that difficult or time consuming to do.

Cost of Infertility:
This was a great segment featuring the Gunderson Lutheran Fertility Center. Dr. Kathy Trumbull was the Reproductive Endocrinologist. Two couples were highlighted, Crystal and Larry as well as Bobbi Jo and Marty. Both of the men apparently had male-factor infertility, Crystal had polycystic ovarian syndrome and Bobbi Jo, stage I endometrioisis.

I couldn’t tell what treatments were used for which couple. Dr. Trumbull’s discussion regarding infertility patients seeing a general physician for the simple stuff but to find a Reproductive Endocrinologist when too much time passes or the issues are growing in their complexity. This is actually a statement that needed to be stated long before now so hats off to Dr. Trumbull. Infertility, especially the issues as presented by TFC, are well beyond anyone’s care besides a Reproductive Endocrinologist.

The issues of cost of infertility care will probably come up again in a future TFC program. It is a difficult issue but few areas of medicine require such a tremendous amount of physician and nursing training, continuous equipment upgrades and an extraordinary amount of time committed to our patients. Hats off to Gundersen Lutheran if they are truly able to make it more affordable in my home state of Wisconsin. I truly wish I could give it away free.

Summary:
Well that is it for now. It was wonderful to be part of The Fertility Chase. Even though my show has aired, my commitment is to continue to watch each program and report back to my readers my thoughts and comments. If you agree or disagree with whatever I say, please do not be shy and leave a comment or two. In the mean time, be fertile.

I liked today’s show a great deal. There was an abundance of information offered at a dizzying pace. Sorry, in advance, for the long post, but there was much to cover.

Single Embryo Transfer:
The University of Iowa Hospitals & Clinics discussed the concept of what is commonly called “elective single embryo transfer” or eSET. Bradly J. Van Voorhis, M.D., Director of the IVF program, was one of the physicians featured. The idea discussed was to transfer only one healthy embryo at a time significantly reducing the risk for multiple pregnancies. He published on this topic in 2007. In today's story, they claimed a 68% delivery rate with a single embryo transfer procedure. According to their previously published data, this probably included egg donation cycles where eggs are removed from very young women and then provided to women who need them.

There is no question that it is ideal to perform an eSET but there are two issues I need to bring up. In many IVF programs, ideal patients are the exception, so eSET may really only be practical for a minority of the patients. Second, other studies have shown a reduction in take-home rates with eSET compared to two embryos, so many patients still request two embryos, even after being warned of the many risks of a multiple pregnancy. It is rare that I am able to convince a patient to electively transfer a single embryo, especially if IVF is not covered by insurance. Americans love a two-for-one sale, even when told of the risks a multiple pregnancy involves.

Cancer and Reproduction:
The second story came from the University of Colorado. This involved the heart-wrenching story of Meghan and Barton. Meghan was diagnosed with some sort of cancer (never described), underwent surgery and radiation, had a recurrence two years later and then received additional surgery, chemotherapy and radiation. I was so very impressed with both of them, especially Barton who so lovingly supported her throughout the process. There was a great picture of the two of them bald probably after the chemotherapy. What a life partner!

After several attempts, a total of four embryos were frozen (cryopreserved). Meghan found an Oncologist who suggested transferring these embryos before the cancer came back, which seemed like an inevitability. I was impressed by Dr. William Schlaff’s honesty explaining the chances that these four cryopreserved embryos would result in a live birth were slim because of her past cancer treatments. I have heard Dr. Schlaff speak before and have always been impressed by his honesty and integrity.

Amazingly, Meghan and Barton became pregnant with the thawed embryos and we were able to see an ultrasound image of an early pregnancy. This case also brings up a very sensitive and difficult side of cancer and reproduction. For patients who have cancer and recurrence, it is really uncertain if they will remain disease free. Many of these patients want to experience life, which often means reproducing. For some, this means having children to fulfill their lives even understanding that some will not survive to raise the child. In addition, by having a child, a part of the cancer patient, a legacy of sorts is left with the surviving partner. I don’t know what cancer Meghan has or her prognosis but it would seem that she might have more trouble ahead. I think they are amazingly brave. She deserves to experience parenthood, which robs so many other cancer patients. Barton is a rare life partner and I truly wish them only the very best.

Dual Training of the Reproductive Endocrinologist:
The University of Colorado facility is unusual in that the Reproductive Endocrinologist are trained to evaluate male infertility. Those types of physicians are rare and are great to have around since one physician is then truly able to care for the couple as a whole rather than trying to get two separate physicians to communicate and agree on a treatment plan. I was fortunate to have been similarly trained and I estimate that at least 25% of my new infertility patients are male.

Egg Freezing (Oocyte Cryopreservation):
Continuing under the theme of cancer, Charles Coddington, III, M.D., Director of the Reproductive Endocrinology Division at the Mayo Clinic, brought up the story of Sarah. Sarah was diagnosed with breast cancer and underwent a double mastectomy, such a difficult decision for such a young woman. In her case, she eventually underwent an egg freezing procedure (oocyte cryopreservation). It is uncertain how many eggs were actually frozen. I thought this piece was well done showing what is possible with today’s technology. Tina was also featured in the segment electively freezing her eggs so she could have a “reproductive insurance policy”.

Trying to Not Create Excess Embryos:
The story of Ceresa and Jonathan was next wherein they tried to only fertilize enough eggs to transfer embryos and then freeze the excess eggs but not have any excess embryos frozen. From what I could tell, two IVF cycles were needed to freeze a total of five eggs. The two fresh embryo transfers resulted in one failure and one miscarriage. For the third procedure, the five eggs were thawed four survived, three fertilized and were transferred resulting in a twin pregnancy.

My personal experience with trying to not create cryopreserved excess embryos has almost always resulted in failure. Trying to get as many healthy embryos as possible, transferring the best and freezing the remaining still provides the best chance for success. Playing the game of fertilizing only a few eggs and freezing the rest does not improve success rates but, in all likelihood, reduces them. It also increased the costs of the cycles. Excess cryopreserved and thawed embryos can be transferred in the couple later or donated to needy patients, so I would almost always suggest fertilizing all the eggs, transfer fresh and free the excess embryos rather than freezing only a few eggs and hoping for the best.

The only issue I had with this entire topic was that it was never made clear that oocyte cryopreservation was experimental requiring a true study with a review board’s oversight. We here at SRMS do have an ongoing oocyte cryopreservation study. We had to go before the hospital Institutional Review Committee (IRC) to give us permission to move forward with the study. I know how careful the IRC is and they would have required to review this segment of The Fertility Chase should this have been my topic. I couldn’t tell if the Mayo Clinic had checked with their IRC before airing their segment but the fact that it was never mentioned that egg freezing was experimental makes me think the committee was never approached.

Please do not misunderstand my writings. I feel this is a very important area of reproductive medicine with the potential to liberate women much as the birth control pill did years many years ago. The reality, however, is that we need to emphasize that oocyte cryopreservation is really experimental and not over promise what we cannot consistently deliver.

Outsourcing Surrogacy:
Next came the couple Karen and Jean. Jean clearly had some difficult luck in that insemination procedures and egg donation cycles didn’t succeed wherein she was then diagnosed with breast cancer. In comes Proactive Family Solutions, which outsources surrogacy to Mumbai, India. From the best that I could tell, Jean’s sperm was combined with an egg donor (American?) and some of the embryos created were placed into an Indian surrogate.

There is no question that surrogacy can be expensive. I couldn’t find any information as to the overall costs Proactive Family Solutions charged but it is undoubtedly less than some locations here in the states. I suspect the option of embryo donation may very well compete in price with Proactive Family Solutions. I would really like to see a head-to-head comparison of the costs to see where the costs here in the states make surrogacy out of reach wherein we should do whatever possible to bring this process back to the states.

Next Week:
Lastly, I felt honored that our piece on embryo donation was the teaser for the next show. Please be sure to tune in next week. I guarantee you will not be disappointed!

Recent Comments

Tune into NBC-2 tonight at 5 p.m.: Reporter Marisa Brahney will share the story of “The Fertility Chase,” a new cable tv series airing May 15 on WE (Women’s Entertainment) television, featuring me and two local patients. The story chronicles their experience with embryo adoption and surrogacy – a true testament to the miracle of modern medicine, friendship and the pursuit of motherhood. For more information, visit www.dreamababy.com.